GW Law Faculty Publications & Other Works
Document Type
Testimony
Publication Date
2026
Status
Working
Abstract
The testimony argues that effective Medicare and Medicaid program integrity requires clear definitions, sustained oversight capacity, and incentives aligned toward prevention rather than retrospective recovery. It stresses that “fraud” is a legal determination and should not be conflated with broader measures of improper payments or documentation deficiencies, because that confusion distorts risk assessments and policy responses. It evaluates the current enforcement ecosystem across CMS, HHS-OIG, DOJ, GAO, and state partners, emphasizing coordination, stable resourcing, and accountability in managed care as central to deterrence. It also highlights how advanced analytics and generative AI can both amplify fraud schemes and strengthen detection, depending on governance, data access, and due process. The recommendations prioritize front-end controls, better data infrastructure, implementation of long-standing oversight recommendations, and preserving effective enforcement and whistleblower mechanisms to reduce losses and improve program performance.
GW Paper Series
2026-15
SSRN Link
https://ssrn.com/abstract=6257338
Recommended Citation
Tillipman, Jessica, Testimony of Jessica Tillipman, Associate Dean for Government Procurement Law Studies, The George Washington University Law School,Common Schemes, Real Harm: Examining Fraud in Medicare and Medicaid, Hearing Before the United States House of Representatives Committee on Energy and Commerce, Subcommittee on Oversight and Investigations (February 3, 2026)